Jay Earley, Ph.D.

Abstract. One form of Gestalt therapy group focuses on the interpersonal interactions and relationships among group members. This is an effective and exciting way to make therapeutic use of the group setting. This practical article discusses how to foster group norms that intensify and maximize the interpersonal aspect of a Gestalt group. We examine pre-group hand-outs and interviews, defining appropriate norms, how group members initiate interpersonal work, encouraging interpersonal norms, and how to move work in an interpersonal direction.

Increasingly Gestalt therapists are using approaches to group therapy that go beyond individual work in the group to include interpersonal interactions or the group-as-a-whole (Feder & Ronall 1980; Harman 1984; Melnick 1980; Zinker 1977, Chap. 7, Handlon & Frederickson, 1998; Earley, 1996). I believe that the interpersonal learning and healing which takes place in the interactions among the group members is very valuable therapeutically, and therefore my approach to Gestalt group therapy emphasizes this.

My Gestalt groups are designed to intensify and maximize interpersonal contact and the work that emerges from this. Much of the work is in pairs, as people explore their feelings towards each other, work on their relationships, and experiment with new ways of interacting. Some of the work involves one person working on his relationship with the group-as-a-whole. This approach embodies Gestalt therapy in its emphasis on contact, awareness, dialogue, and experimentation.

This group work is similar in some ways to the interpersonal group method of Yalom (1995). However, unlike Yalom, I emphasize awareness and the experiential exploration of underlying intrapsychic issues. I also pay attention to contact and intimacy issues and use an active leadership style. All these differences are characteristic of Gestalt therapy.

In my years of training Gestalt therapists in this method, it has been especially important for them to learn how to focus a group in an interpersonal direction. Therefore, this article discusses the practicalities of developing group norms that emphasize interpersonal work. This approach to group therapy is discussed in detail in my forthcoming book Interactive Group Therapy.

Levels of Dynamics

First let’s discuss the three primary levels of dynamics operating in groups:

1. Intrapsychic. The usual psychological dynamics therapists normally explore in individual therapy, including motivation, emotions, defenses, projections, etc.

2. Interpersonal. The dynamics that go on in the relationship between any two or more people in the group, including emotional reactions, closeness, assertiveness, boundaries, etc.

3. Group-as-a-whole. The dynamics of the group taken as a unit, including stages of development, group norms, group roles, emergent leadership, scapegoating, group-level resistance, etc.

At any given moment, the leader can choose to address a particular level. For example, if you felt that absences and lateness were seriously hampering the group, you might focus on that group level problem. You might choose instead to focus on Jill’s communication pattern or Jeff’s transference.

The Value of Various Levels. I believe that the interpersonal interactions among the members provide the greatest therapeutic leverage in a group setting. In a group setting, the interpersonal level is often the place which is figural for group members because of their needs for connection, acknowledgement, and safety, and because of their emotional responses to other group members. This provides a natural way to use the Gestalt focus on the present moment and contact. The interpersonal focus stimulates and brings out the emotional reactions and transferences that are the lifeblood of therapy and also provides an ideal venue for clients to experiment with new behavior and receive healing responses from other group members.

The intrapsychic level is important because it is the domain in which members become aware of their experience, access deeper feelings, and engage in other processes that are directly related to therapeutic change.

Group-as-a-whole dynamics provide the context for the interpersonal and intrapsychic levels. The leader must monitor this level in order to prevent or remedy problems in the overall operation of the group. In the early stages of a group, the leader must pay attention to the development of appropriate group norms, as discussed in this article. I prefer to use group level interventions only when they are needed to help resolve a difficulty at the group level. Otherwise I focus directly on the intrapsychic and interpersonal levels which have the greatest potential for therapeutic change. This attitude is similar to Yalom’s (1995).

Group Norms

Group norms specify those ways of being that are preferred or expected in the group and those that are frowned on or prohibited. Group norms can be explicit or implicit, consciously chosen by the leader or the group, or unconsciously arrived at without any explicit discussion. (Yalom, 1995, p. 109-128)

Rules and Norms. Group norms are different from group rules. Group rules are explicit and are not to be broken without good reason. Examples would be rules that prohibit violence or coming to group intoxicated. Group norms, on the other hand, are looser because they constitute general behavioral guidelines. For example, a common norm stipulates that one should speak directly to other group members rather than about them.

How Norms Develop. Some norms are promulgated by the group leader, some come from the group, and some involve negotiation between the leader and group. A leader will need to establish certain therapeutic norms for the group to be effective in fostering healing and change. For example, it is important that members talk about their feelings and explore their psychological issues. Without this norm, a group can easily lapse into idle chatter. The leader should be conscious of therapeutic norms, so you can promote them, both explicitly and implicitly. It’s best if they grow out of give and take between the leader and the group. If the group exerts too much influence, the norms may not be therapeutic. If the leader simply imposes norms, however, group members may feel powerless or resentful.

Many group norms come primarily from the group members, and as long as these norms aren’t anti-therapeutic, the leader can allow each group to establish its own. For example, some groups prefer longer and deeper pieces of work focused on one or two people at a time. Other groups prefer more open and spontaneous group interactions, which allow members to interrupt more frequently to express their feelings or opinions. As long as a group doesn’t go too far in either direction, the leader can allow the group to develop its own balance.

Interactive Work

Because of the potency of the interpersonal level, I recommend that early in a group leaders establish the norm that work will focus on the relationships among group members and their interpersonal interactions. The leader can use a variety of means, described in this article, to establish this norm. If you are leading a group that combines interpersonal work with another group modality (such as individual work in the group), it is especially important to establish interpersonal norms, even though they aren’t the only norms for the group. Since interpersonal work is the most threatening modality for most people, group members may give it short shrift in favor of safer ways of working unless the leader vigorously promotes the norm.

Defining Interactive Work. Therefore, it is helpful to give beginning group members as much guidance as possible on the purpose and style of interpersonal group work. This is especially valuable in limited-time groups because it moves the group quickly into the most productive work. However, I find it useful in long-term groups as well. I explain to prospective members ahead of time that the group will be "interactive" (my colloquial word for interpersonal) and discuss what this means, making a clear distinction between interactive work and outside issues. Interactive work involves "Talking to someone in group about your feelings toward each other or about your relationship, or bringing up what you feel in the group or in the moment." Outside issues mean "Bringing up issues from your current life outside group or your past, or discussing your psychological issues in general or other topics." I explain this in the pre-group interview and in written material given to members before they join. I emphasize this distinction whenever necessary during the formative stages of a new group. No matter how much you explain beforehand what interactive work is, some people won’t really get it until they have seen it in vivo a number of times and initiated interactive work themselves.

The Value of Outside Issues

Though interactive work is the focus of the group, work on outside issues should not be ruled out. After all, if the group members are to develop close relationships, they must get to know each other’s lives. Under some circumstances, it is helpful to actually encourage work on outside issues:

1. If a client has strong feelings about an issue, especially if he is so caught in it that he can’t be present in group on a particular day. Talking about the issue may relieve the emotional pressure and include the group in the person’s struggle. Then he can let go of it for the evening and get involved in the group.

2. If sharing the issue will help the group to know the person at a deeper level. This is especially important for new members or a new group.

3. If the outside issue is related to something happening in group. For example, if a man is having difficulty with intimacy in the group, he might discuss intimacy issues in his marriage.

4. If sharing the issue with the group constitutes an interpersonal challenge for the person, so it is really interactive work. For example, suppose a woman has difficulty asking for emotional support, and she needs help with an outside issue. Then talking to the group about this issue will bring up her difficulty with support so it can be worked on interactively.

Initiating Interactive Work

In keeping with the Gestalt emphasis on responsibility, encourage group members to initiate interactive work themselves. There are two general ways for a client to do this:

(1) Express her reactions in the moment to an event in group or to something another group member said or did.

(2) Bring up work that relates to previous meetings or longer term issues, especially feelings toward another member, or concerns about their relationship, or issues with the group-as-a-whole. Encourage clients to reflect on what work needs to be done on a given night, and come to group with an idea of what to initiate.

Ways of Initiating. To be more specific, there are five useful ways to begin interactive work. A group member can:

1. Talk about what he is experiencing in the moment. This provides practice in awareness and can lead to any of the other possibilities below.

2. Bring up an issue with someone in group or with the leader--a reaction or feeling toward that person. This typically leads to a dialogue between the two people.

3. Reach out to someone in group or to the leader--to get to know her better or to become closer to her. Emphasize that clients don’t need to have an "issue" with someone to initiate work on the relationship. Group members sometimes think they can initiate interactive work only when they have a problem with someone. In fact, they can also initiate work with people they like as a way of becoming closer. This often brings up issues people have about contact, intimacy, or reaching out to others. A good way to begin such work is for one person to tell the other what he likes about her.

4. Bring up an issue with the group-as-a-whole. This could be something happening in the moment, such as feeling close to the group or angry at the group. It could also be a longer standing issue, such as feeling left out of the group or perceiving cliques in the group.

5. Ask for feedback from someone or from the group as a whole. This feedback could revolve around a specific issue, such as a member wanting to know if people feel intimidated by him. Or it could concern something general such as a client wanting to know how other members are responding to him. This is a common question for new members.

It helps to spell out these possibilities so members can take responsibility for initiating interactive work.

Ways of Relating

To further clarify the interpersonal norm, let’s look at four different ways that one group member can relate to another.

1. Facilitation. A client attempts to help another group member (without becoming personally involved, as a group leader might) by asking questions, making interpretations, giving advice, and making suggestions.

Facilitating can occasionally be useful in a group if the person receiving it really wants it at the time. Group members with low self-esteem can benefit from discovering that their facilitations are really helpful to others. Facilitation can also be valuable when it is experienced as a sign of caring; this is often more important than the content of the help. However, if the client doesn’t want facilitation or doesn’t find it helpful, it can be experienced as intrusive, controlling, or insensitive. Especially if the person offering it can’t let go when it isn’t received. In this case, you may want to work with the person offering the facilitation on his reason for needing to give it or his lack of sensitivity to other people’s needs.

The danger of a facilitation is that it can hide the real feelings of the person offering the help. Sometimes a facilitation simply comes from a desire to help, but other feelings or agendas may also be at work. For example, Stan makes an interpretation about a woman’s anger that sounds plausible, but she is put off by it. On further exploration it turns out that Stan has felt hurt by her anger in the past, and his interpretation was an attempt to get back at her. It is especially important to prevent a client from regularly using facilitations to avoid dealing with his own feelings and issues. In this case, you can turn a facilitation back to the person by asking,

"Is there anything coming up for you that prompted you to offer that interpretation (question, etc.)?"

Some methods of group therapy encourage facilitations in the form of interpretations. Ormont (1992) calls this "bridging" and values the fact that group members become more involved with each other than if interpretations come only from the therapist. While this is certainly true, I think it is more valuable to encourage group members to get directly involved with each other through giving feeling responses. Otherwise they can hide their own feelings behind interpretations of others.

2. Empathy and Identification. These are ways of responding in a parallel way to another person, resonating with the person. For example, suppose Mary says, "I feel sad because it seems that I don’t belong in this group." (a) Empathy means feeling some of Mary’s sadness in resonance with her. This might be expressed as follows: "I really feel what you’re going through." (b) Identification means knowing what it is like to feel what Mary is feeling you have had a similar experience or struggled with the same issue. This might be expressed as: "I feel that way at work sometimes. It’s a real bummer."

Empathy and identification play an important role in promoting caring, vulnerability, and group cohesiveness. They help connect people with each other and promote a sense of safety in the group. People also learn from each other’s issues through identification. As one person is working on an issue, others should be encouraged to notice how the work resonates with them. They can gain valuable insight into themselves by paying attention to their reactions. In addition, if one person has a powerful experience of access, this may trigger other group members into accessing their own deeper material. Then they can each work on accessing the feelings that were brought up. However, if you are working with a group of more disturbed clients with fragile defenses, this process of contagion can be dangerous and chaotic because they may not be able to hold their feelings until they can get the leader’s attention. Then you must help them learn more effective defenses and ways to contain their feelings so that the group doesn’t get out of hand.

Empathy and identification can also be used to avoid confrontation or differences. Watch for clients relating to others only through resonating with their feelings and never by expressing their own direct feeling responses.

3. Perception. This means talking about one’s view or understanding of another person. For example, as a response to Mary, "It seems like you keep yourself from being part of the group." A perception contains elements of both facilitation and feeling response. It can be useful as feedback, but make sure the person giving the perception isn’t using it to avoid a feeling response. People often state perceptions as if they were feelings. For example, "I feel like you keep yourself from being part of the group." Make a clear distinction between perceptions and feelings, and ask for the person’s feeling response when that is called for. For example, you might say: "That’s your perception about Mary. How do you feel toward her?" For the most part, clients should be talking about themselves, not the other person. Feedback in the form of perceptions of others is certainly a valid way of responding, but not if it is used to avoid expressing one’s own reactions. When you sense that there is something peculiar about the way a person expresses a perception, ask him to explore his feeling response to the other. Often instead of just a neutral observation, there is a hidden feeling response.

4. Feeling Response. This means expressing an emotional reaction to the other person. This could be a positive reaction, such as caring, appreciation, or support. For example, as a response to Mary, "I want you to belong here. I care about you." Notice that this is not the same as empathy or identification. Here the person is expressing his emotional response to Mary, not how he feels similar to her. Alternatively, it could be a negative reaction such as anger or judgment. For example, to Mary: "I’m annoyed. There you go again feeling sorry for yourself." It also could involve wide variety of other emotions, including envy, fear, shock, amusement, admiration, etc. In an interactive group, I emphasize feeling responses because they lead directly to interactive work.

Fostering Interactive Work

Interactive work tends to build on itself. As group members begin to talk about their emotional reactions to each other, this generates additional emotional reactions and therefore provides more interpersonal material to work with. This positive snowball effect leads the group members more and more deeply into interpersonal work with each other. On the other hand, if group members emphasize individual work on outside issues and ignore their feelings toward each other, then over time, they have fewer feeling reactions to work with because the focus of the group has shifted elsewhere. If this happens, encourage the group members to return to interacting with each other. If they claim that they don’t have many feelings toward each other to work with, this is both because they are ignoring their feelings toward each other because of the shift away from interaction. There are always some feelings among group members to work with, and once the group shifts back to interactive work, the interpersonal material will gradually increase.

Here are some suggestions for encouraging group members to do interactive work:

1. Ask for it explicitly. When a group has focused on outside issues for a while, it can be helpful to point this out and suggest that the next work be interactive. In the early stages of a group, you can teach group members about initiating interactive work using a simple exercise as follows: Suggest that each member think of one other person in the group toward whom she has feelings which haven’t yet been expressed. Then ask someone to volunteer to begin by expressing these feelings to the person she picked. If appropriate, allow this to expand into an interaction between the two people. Then ask for another volunteer, and so on.

2. Set up interactive work in individual sessions (if you are seeing a client in individual therapy as well). This is especially useful during the first few months of a person’s being in group. In the safe setting of an individual session where only you will hear them, clients are often able to access feelings towards others in the group that don’t come up in the more threatening group setting. In the session, ask the client to consider each group member in turn and tell you her initial impressions or feelings towards that member. After she has described her feelings, explain that she could bring out these feelings in group as a way of initiating interactive work. If she is too frightened to do this, you can work with her on her fears to help prepare her to do the work. In any case, the client should be allowed to choose when she is ready to tackle this work.

3. Encourage people to explore their blocks. If you notice that people seem to be avoiding interactive work, you can ask them to explore what’s behind their reluctance. They might discover that they are afraid of stirring up conflict or being judged or dealing with intimacy issues. Make it clear that they can do this exploration without having to initiate the work that they are afraid of. They don’t even have to divulge what it is. If this provides enough freedom for them to explore what is stopping them, they are usually quite willing to initiate the work

4. Point out emotional reactions. Be on the lookout for signs of any subtle emotional reaction that one member may be having toward another or toward the group. If you point it out at the moment and ask him about what he is feeling, this often gets things rolling. For example, suppose the group is discussing a topic and you notice that someone rolls her eyes in response to Mary’s comment. You can say, "I noticed you had a reaction just then to what Mary was saying. What was it?"

Moving from Outside to Interactive Work

In most cases, even when it is appropriate for a client to bring up an outside issue, it is helpful to focus your facilitation on how the client is relating to the group (and they to him) rather than on the issue itself. It is surprising how often what looks like purely outside work has important interpersonal ramifications. When a person is sharing an outside issue, there are a number of interventions that can move the work in a more interactive direction:

1. Ask the group member if he has that issue with anyone in group. For example, suppose Hank is saying that he gets intimidated by certain kinds of women. You can ask him if he has felt intimidated by any of the women in the group. Or if you have noticed this issue in group, point it out. For example, you could mention that Hank seemed to be intimidated by a certain woman in an earlier group meeting.

2. Ask the person to notice when he has that reaction in group and bring it up right away. For example, ask Hank to pay attention to his interactions with the women in the group and notice if he feels intimidated at any point.

3. If the issue involves difficulties in reaching out or connecting with others, suggest that the member pick someone in group that he would like to connect with. For example, a man talks about how isolated and lonely he feels and how difficult it is for him to make friends. In exploring this, it emerges that he is frightened to initiate connections with people for fear they won’t be interested in him. You could suggest that he pick someone in the group that he would like to get to know better (or become closer to) and experiment with connecting with that person. Of course, even picking someone and revealing this to the group may be terrifying, but he doesn’t actually have to do this in order to benefit from this work. Even if he only gets as far as feeling the fear, you can then work with him on accessing the fear and learning more about it. If he is then able to reach out to the person, you can work with him on the way he expresses himself or the way he reacts to the person’s response.

4. While a client is sharing an outside issue, it is often useful to work with him on becoming more present while talking about it. If someone talks about an emotional issue in a matter-of-fact voice or as an entertaining story, you can help him to identify the underlying feelings and to express them to the group. Once this brings him more into contact with himself and the group, he is likely to explore the issue more deeply or interact with someone.

5. Ask how it feels to be sharing this issue with the group. How is the client feeling about the way the group is responding to him? Is it meeting his needs? This focuses the person on his interactive process with the group rather than only on the content of the outside issue. For example, the client might say, "Oh, it’s a great relief to be saying this, because I can see that people don’t think I’m ridiculous." This reveals a fear he was struggling with. On the other hand, if the client’s response indicates that he is self-absorbed and out of contact with the group, you can explore this with him.

6. Ask what the group member needs or wants from the group in sharing the issue. Typically a person will need caring of some kind—empathy, compassion, identification, appreciation, acceptance, or understanding. He may also need advice, permission, or encouragement. Often people have a hard time identifying what they need, so you may need to suggest possible alternatives. The process of struggling to identify needs can be very helpful. It also prevents the person from just telling stories without making contact with the group. For example, Melissa shared with the group that her daughter was having a baby as a single mother and Melissa was excited about helping her but didn’t want to be too intrusive. When I asked Melissa what she wanted from the group in sharing this, she realized that it was very important for her to tell the group that she was excited and proud. The group knew that Melissa had been born out of wedlock and was made to feel tremendous shame about this as a child. She knew that the group would understand how important it was that she didn’t feel any shame about her daughter’s plans.

Once the person’s needs are identified, you can explore the dynamics between the person and the group: (a) Is the group meeting the person’s needs? (b) If so, is she taking it in? (c) Is she sharing in such a way as to keep the group from meeting her needs? She may be boring, out of contact, playing victim, etc. (d) Is she afraid to let the group know what she needs? Does she think she doesn’t deserve it, or that she will be shamed for having needs?

7. Have the client pick one group member to share the outside issue with, and explore the emotional contact between them. This is another way to explore the dynamics of the sharing, but in this case, there is a greater opportunity for the other to respond (since it isn’t a whole group), and this makes the dynamics clearer and easier to work with. For example, it highlights the degree to which the client actually makes himself vulnerable to the other. And if the other person responds in a caring way, how does the client deal with that?

Conclusions

The interpersonal level of group work provides a powerful medium for therapeutic change. This article discusses various ways of fostering interpersonal group norms and moving work in an interpersonal direction.

References

Earley, J. (1996). Healing through relationship in an interactive Gestalt group. In Feder, B. and R. Ronall ed. A Living Legacy of Fritz and Laura Perls: Contemporary Case Studies.

Feder, B. and R. Ronall ed. (1980). Beyond the Hot Seat: Gestalt Approaches to Group. New York: Brunner/Mazel.

Handlon, J. H. and Fredericson, I. (1998). What changes the individual in Gestalt groups? Gestalt Review, 2: 275-294.

Harman, R. (1984). Recent developments in Gestalt group therapy. International Journal of Group Psychotherapy. 34: 473-483.

Melnick, J. (1980). Gestalt group process therapy. Gestalt Journal. 3: 86-96.

Ormont, L. (1990). The Group Therapy Experience. New York: St. Martin’s.

Zinker, J. (1977). Creative Process in Gestalt Therapy. New York: Brunner/Mazel.

Yalom, I. (1995). The Theory and Practice of Group Psychotherapy, Fourth ed. New York: Basic Books.